Citation Nr: 21024967 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-24 550A DATE: April 27, 2021 REMANDED Entitlement to service connection for bilateral pes planus, to include as secondary to service-connected bilateral ankle tendonitis, is remanded. Entitlement to service connection for hallux valgus of the left foot, to include as secondary to service-connected bilateral ankle tendonitis, is remanded. Entitlement to service connection for bilateral hammertoes, to include as secondary to service-connected bilateral ankle tendonitis, is remanded. Entitlement to service connection for fat pad atrophy of the bilateral feet, to include as secondary to service-connected bilateral ankle tendonitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1976 to October 1979. This matter comes to the Board of Veterans’ Appeals (Board) from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Board remanded these matters for further development. Unfortunately, another remand is necessary. 1. Entitlement to service connection for bilateral pes planus, to include as secondary to service-connected bilateral ankle tendonitis is remanded. The Veteran claims that she had preexisting bilateral pes planus that was aggravated in service. See January 2020 VA examination report. Bilateral pes planus is not noted in the Veteran’s service treatment records, including her entrance and separation examination reports. However, an August 2005 VA treatment note documents a provisional diagnosis of pes planus congenital, and a May 2013 VA examiner has stated that the Veteran’s bilateral pes planus is “clearly a preexisting condition” that the Veteran has had since childhood. When no preexisting condition is noted upon entry into service, the veteran is presumed sound. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). The burden then falls on VA to rebut the presumption of soundness by clear and unmistakable evidence that the veteran’s disability was both preexisting and not aggravated by service. Id. Once VA provides an examination, it must be adequate, or VA must notify the Veteran why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). No VA opinion of record, including the latest VA opinion dated in January 2020, has addressed whether the Veteran’s bilateral pes planus was aggravated in service. Accordingly, the matter is remanded. 38 C.F.R. § 4.2. 2. Entitlement to service connection for hallux valgus of the left foot, to include as secondary to service-connected bilateral ankle tendonitis is remanded. 3. Entitlement to service connection for bilateral hammertoes, to include as secondary to service-connected bilateral ankle tendonitis is remanded. 4. Entitlement to service connection for fat pad atrophy of the bilateral feet, to include as secondary to service-connected bilateral ankle tendonitis is remanded. The Veteran has claimed service connection for hallux valgus of the left foot, bilateral hammertoes, and fat pad atrophy of the feet, and has indicated that these disabilities are secondary to her bilateral pes planus. These issues are inextricably intertwined. Smith v. Gober, 236 F.3d 1370, 1373 (Fed. Cir. 2001) (where facts underlying separate claims are “intimately connected,” interests of judicial economy and avoidance of piecemeal litigation require that the claims be adjudicated together). Accordingly, the Board will defer adjudication of these issues pending the development directed below. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of her bilateral pes planus. The examiner must review the claims file in its entirety, including this Remand, and must note that review in the examination report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should provide an opinion as to the following: a) Does the evidence clearly and unmistakably show (i.e., it is undebatable) that the Veteran’s bilateral pes planus existed prior to service? The examiner is reminded that lay statements by a Veteran concerning a preexisting condition are not sufficient to rebut the presumption of soundness, even when such is recorded by medical examiners. b) If the answer to a) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the pre-existing bilateral pes planus WAS NOT aggravated (i.e., permanently worsened) by service or that any increase in disability was due to the natural progression of the disorder? c) If the examiner answers “yes” to both a) and b), the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the left foot hallux valgus, bilateral hammertoes and bilateral fat pat atrophy were caused or aggravated by the bilateral pes planus. If the examiner finds aggravation the examiner should indicate to the extent possible the approximate degree of disability or baseline before the onset of the aggravation. The examiner should provide a complete rationale for any opinion provided. If the examiner cannot provide any requested opinion without resorting to speculation, they should expressly indicate this and provide a rationale as to why an opinion cannot be made without resorting to speculation. Megan R. Thomas Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph R. Keselyak, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.